Become a Pro Member for full access to this course and more.

View Plans   Log In
Expand ("E")   Collapse

Age: 35

Sex: Male

Indication: Gunshot wound to the abdomen

Save ("V")

Case #7


Findings

  • Lower chest
    • Mild dependent atelectasis
  • Abdomen/Pelvis
    • Mural thickening of the distal sigmoid colon with adjacent hemorrhage, moreso along the right wall, and small volume pneumoperitoneum
    • Short segment mural thickening of the terminal ileum with adjacent hemorrhage
    • Contrast density focus in the ileocolic mesentery which increases in size on delayed images
    • Small volume hemoperitoneum with a small amount of fluid extending into the left inguinal canal
    • Colonic diverticulosis
    • Bilateral renal subcentimeter hypodensities, which are too small to characterize
  • MSK
    • Acute, comminuted, minimally displaced right sacral fracture with involvement of the S3 and S4 neural foramina
    • Adjacent small right piriformis intramuscular hematoma with a small focus of contrast density which increases in size on delayed images
    • Retained ballistic fragment in the lower left ventral abdominal wall just superficial to the rectus musculature
    • Soft tissue contusion and subcutaneous gas in the right gluteal region


Diagnosis

  • Bowel injury

Sample Report

Findings are concerning for focal traumatic perforation of the distal sigmoid colon related to gunshot injury. Small volume associated hemopneumoperitoneum. Likely additional site of injury and possible perforation involving the terminal ileum.

Ileocolic mesenteric injury with a small area of active bleeding.

Right sacral fracture involving the right S3 and S4 neural foramina with an adjacent right piriformis intramuscular hematoma and small area of active hemorrhage.

Likely bullet entry site in the right gluteal region with retained ballistic fragment in the lower left ventral abdominal wall just superficial to the rectus musculature.


Discussion

Become a Pro Member to unlock the discussion.

View Plans   Log In


Images

Red arrows: wall thickening and likely discontinuity along the right aspect of the distal sigmoid colon with adjacent hemorrhage, concerning for bowel injury/perforation. Red arrows: small area of active bleeding in the ileocolic mesentery which increases in size and decreases in density between arterial (left) and delayed (right) images. Red arrows: small area of active bleeding in the right piriformis muscle which decreases in density between arterial (left) and delayed (right) images.



📣 Feedback?

⌨️  Keyboard Shortcuts ("K")

Call Preparation

Prepare for call efficiently with interactive cases, sample reports, and annotated images.

1,400+ cases  91.25 CME

Call Simulator

   Neuro CT

250 cases

  Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   KUB

43 cases

   Body CT

140 cases

   Ultrasound

75 cases

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

Neuro Fellowship

Reviews of neuro topics with clinical pearls, differentials, and in-depth discussions.

131 cases  13.1 CME

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

   Congenital Hearing Loss

13 cases

Call Preparation

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Ultrasound

75 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   Body CT

127 cases

   KUB

43 cases

Neuro Fellowship

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

Call Simulator

• Shuffle cases from our courses.
• Submit your own report.

CME

• Earn up to 91 CME.
• Claim your CME to receive a certificate.

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

On Call

Quick references created specifically to help while on call.

  Peds Normals by Age

Reference database of normal imaging from birth to age 16

   Incidental Findings

Summary of consensus guidelines for managing incidental CT findings

   Media Index

Index of select illustrations & videos from our courses

  Neuro CT Mimics

Visual reference for common mimics of pathology on CT

On Call

  Peds Normals by Age

Reference database of normal imaging from birth to age 16

   Incidental Findings

Summary of consensus guidelines for managing incidental CT findings

   Media Index

Index of select illustrations & videos from our courses

  Neuro CT Mimics

Visual reference for common mimics of pathology on CT

Anatomy

Labelled radiographs and CT/MRI series teaching anatomy with a level of detail appropriate for medical students and junior residents.

   Pelvis

Pelvic MRI anatomy

   Chest

Chest radiograph & CT anatomy

   Body

Abdominal CT anatomy

   Cardiac

Cardiac CT anatomy

   Brain

Brain & calvarial anatomy on CT/MRI

   Cranial Nerves

Cranial nerves on MRI

   Shoulder

Shoulder MRI anatomy

   Knee

Knee MRI anatomy

   Temporal Bone

Resident/fellow-level anatomy

Anatomy

   Pelvis

Pelvic MRI anatomy

   Chest

Chest radiograph & CT anatomy

   Body

Abdominal CT anatomy

   Cardiac

Cardiac CT anatomy

   Brain

Brain & calvarial anatomy on CT/MRI

   Cranial Nerves

Cranial nerves on MRI

   Shoulder

Shoulder MRI anatomy

   Knee

Knee MRI anatomy

   Temporal Bone

Resident/fellow-level anatomy

Neuro Courses

Includes our call preparation neuro courses (Neuro CT and Neuro MRI) and our neuro fellowship courses.

   Neuro CT

250 cases

  Neuro MRI

146 cases

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

   Congenital Hearing Loss

Coming soon

Neuro Courses

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

  Congenital Hearing Loss

Coming soon

CME

• Claim your CME to receive a certificate.

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Ultrasound

75 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   Body CT

140 cases

   KUB

43 cases

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

⌨️ Keyboard Shortcuts

View shortcuts

Zoom/Pan

  Full screen

  Window/Level

  Expand/collapse

  Scroll

  Save the case

  Close case/tab

Previous Slice (PC)

Next Slice (PC)

SHIFT Previous Slice (MAC)

 SHIFT Next Slice (MAC)

 Toggle presets

 Previous series (if multiple)

 Next series (if multiple)

  Previous case (⌘ ◄ on a mac)

  Next case (⌘ ► on a mac)

Toggle dark mode